What is rural cooperative medical care

(1) The establishment and development of rural cooperative medical system

Cooperative medical care is a cooperative medical system in China’s rural society that raises funds through collectives and individuals. A mutual aid system used to provide low-cost medical care services to rural residents. It is not only a distinctive component of China's medical security system, but also an important part of China's rural social security system.

As early as the Anti-Japanese War, cooperative medical care was established in the liberated areas with farmers raising funds. After the founding of the People's Republic of China, some places, inspired by the agricultural mutual aid and cooperation movement after the land reform, established public welfare health stations and medical stations with spontaneous funds raised by the masses; in 1956, the "Advanced Agriculture" was passed at the third session of the first session of the National People's Congress. The Model Articles of Association of Producer Cooperatives also stipulates that cooperatives are responsible for the medical treatment of members who are injured or sickened on the job, and must consider working days as subsidies, thus giving the collective the responsibility to intervene in the medical treatment of members of rural society for the first time. Subsequently, collective health and medical stations, cooperative medical stations or coordinated medical stations that were based on the collective economy, combined the collective and the individual, and helped each other began to appear in many places. It can be said that from the founding of the People's Republic of China to the late 1950s, rural cooperative medical care was in the stage of spontaneous construction in various places.

In November 1959, the Ministry of Health held a national rural health work conference in Jishan County, Shanxi Province, and formally affirmed the rural cooperative medical system. Since then, this system has gradually expanded in the vast rural areas. In September 1965, the Central Committee of the Communist Party of China approved and forwarded the "Report on Focusing Health Work on Rural Areas" of the Party Committee of the Ministry of Health, emphasizing the strengthening of rural grassroots health care work, which greatly promoted the development of rural cooperative medical security. By the end of 1965, some cities and counties in more than 10 provinces, autonomous regions, and municipalities including Shanxi, Hubei, Jiangxi, Jiangsu, Fujian, Guangdong, and Xinjiang had implemented the cooperative medical system, and it was further moving toward universalization; even in the "cultural era" During the "Great Revolution", as cooperative medical care was very popular among farmers, by 1976, 90% of farmers across the country had participated in cooperative medical care, thus basically solving the problem of difficulty in seeing a doctor for the majority of rural members of society and laying the foundation for the development of rural medical security in New China. Wrote a glorious page.

However, after the late 1970s, rural cooperative medical care was destroyed and began to decline. In December 1979, the Ministry of Health, the Ministry of Agriculture, the Ministry of Finance, the State Administration of Medicine, and the National Supply and Marketing Cooperatives jointly issued the "Rural Cooperative Medical Care Charter (Trial Draft)". According to this charter, various localities have implemented regulations on rural grassroots health organizations and cooperative medical institutions. The medical system was rectified, adhering to the principle of voluntary participation by farmers, emphasizing voluntary participation and freedom of withdrawal, and improving fund-raising methods. Since then, although rural cooperative medical services have been restored and developed in a few areas. However, with the implementation of the rural contract responsibility system in the 1980s, the accumulation of rural public funds declined, management was ineffective, and health administrative departments at all levels failed to strengthen guidance in a timely manner. Most rural areas across the country were originally based on the collective economy. Due to the disintegration or suspension of the cooperative medical system, most village clinics (cooperative medical stations) became private clinics of rural doctors. According to a 1985 survey in 45 counties in 10 provinces across the country, only 9.6% of rural residents still participated in cooperative medical care, while self-paid medical care accounted for 81%. In 1986, the number of villages supporting cooperative medical care continued to drop to about 5%. At that time, only a few areas such as suburban counties in Shanghai, Zhaoyuan in Shandong, Wuxue in Hubei, Wuxian, Wuxi and Changshu in Jiangsu continued to adhere to cooperative medical care.

In the late 1980s, the medical problems of rural members of society have attracted the attention of relevant government departments. On the basis of summarizing historical experience and based on the development and changes of rural areas, some places have also begun to reform the traditional cooperative medical system. Improvements were made to suit local conditions, resulting in different models. At present, rural cooperative medical services, as an aspect of rural social security services, have been included in the development plan of the national health department and are gradually recovering and developing.

In summary, it can be seen that China’s cooperative medical care industry has taken a tortuous path. This twist and turn is different from other social security systems. It is mainly because the implementation of the rural contract responsibility system has made it lose its Due to the collective economic foundation and the lack of effective policy guidance, the result was that the number of rural social members participating in the cooperative medical system dropped sharply from 90% of the rural population in 1976 to about 5% in 1986. In some places, it was difficult for farmers to seek medical treatment. , the phenomenon of looking down on illness and even falling into trouble or desperate situation due to illness. The tortuous development process of rural cooperative medical services should serve as a profound lesson for China’s entire social and economic reform and development at this stage.

(2) Characteristics of cooperative medical care

In the past few decades, China’s rural cooperative medical system has had successes and setbacks, and is still at a low ebb. However, Its characteristics are distinct.

1． The cooperative medical care targets rural residents. In China, urban residents generally have public health care, labor insurance medical care or medical and social insurance systems to provide health care and disease medical protection. However, members of rural society, which account for more than 70% of the country's total population, lack necessary medical protection. As a medical security system gradually formed and developed by farmers in their long-term struggle against diseases, cooperative medical care has become the main basis for solving the medical and health care problems of rural residents.

Therefore, cooperative medical care was created by farmers and serves their health, and is thus an important part of the rural social security system.

2． Cooperative medical care is based on the principle of mass voluntariness. Cooperative medical care is a product of the cooperative movement, and its essence is mutual aid among the masses. It has emphasized the principle of mass voluntariness from the beginning, and attracted the masses to participate through policy guidance, implementation effect guidance, and mass mutual influence. For example, the state attaches great importance to and supports cooperative medical care in policy, and regards cooperative medical care as a practical service for rural residents; the public welfare and welfare of cooperative medical care itself make farmers realize its benefits; the influence among the masses can also promote rural The active participation of social members; the cooperative medical system was voluntarily participated by farmers under the guidance of the above three factors and eventually became a medical care system. In the new historical period, cooperative medical care should still adhere to the principle of mass voluntariness, but this does not exclude policy guidance, government support and other measures to guide the voluntary participation of the masses to voluntary participation of the masses, making cooperative medical care a mass medical security in rural society system.

3． Cooperative medical care is based on the collective economy. In the past few decades, the cooperative medical system has been adapted to the collective accounting system of rural cooperatives and teams. Its funding mainly comes from subsidies from collective public welfare funds. Members only need to pay a small fee for medical treatment, making it a low-paying rural collective welfare undertaking. . After the rural reform, cooperative medical care went into decline precisely because it lost the guarantee of this collective economy. Based on the actual conditions in rural China, it is impossible for farmers to bear this responsibility alone, whether in rich or poor areas. Protecting and improving national health are the responsibilities of the country and society. Although it is impossible for the country and various governments to go back to the old path of urban residents' medical security system in rural areas, which is facing many difficulties, they cannot let it go. Therefore, the state and society's responsibilities for the health of rural residents will be mainly realized through policy guidance and contributions from the rural collective economy. The collective economy was the economic basis of cooperative medical care in the past and will continue to be the economic foundation of rural cooperative medical care in the future. Necessary foundation

Basics.

4. Cooperative medical care provides comprehensive services. Although the cooperative medical care is at a low level and has simple facilities, judging from the practice over the past few decades, it has very rich content. In areas where cooperative medical care is implemented, it not only provides general outpatient and inpatient services to members of rural society, but also undertakes tasks such as children's planned immunization, women's maternal health care, family planning, and endemic disease epidemic monitoring. Carry out various prevention work, food and drinking water hygiene, patriotic health work, etc. in conjunction with the policy. It can be seen that although the cooperative medical system is established in townships and villages and is the lowest level and extensive medical security in China, "although a sparrow is small, it has all the five internal organs" and plays a multi-faceted positive role in ensuring the health of rural social members1 ． Village-run and village-managed type. That is, cooperative medical stations (sites) are prepared and built by themselves and are managed by the village committee. Their funds are jointly borne by the village collective economic organization (or village bureau) and the people of the village. The implementation targets are limited to residents of the village, and individuals can enjoy cooperative medical services. and standards are set by villages, it was the main form of rural cooperative medical care in China in the past. For example, in 1985, among the 3,037 villages that implemented cooperative medical care in suburban counties in Shanghai, 83.5% were managed by village offices and villages.

2． Village-run and township-governed type. Under this model, cooperative medical stations (points) are still prepared and established by village committees, and cooperative medical funds are jointly raised by collectives and individuals. However, the scope and standards of enjoyment are determined by the village and township through consultation, and funds are provided by the township health center. Or the township cooperative medical management committee shall manage it uniformly and calculate it on a village-by-village basis. Excessive expenditures shall be borne by each village.

3． Rural joint-run type. Under this model, cooperative medical stations (sites) are built by townships and villages. In addition to the village collective retention and individual contributions, the township-level government also subsidizes part of the cooperative medical funds; the funds are managed by the township, and the township and village accounts are divided. , the retention and reimbursement ratios are determined through negotiation between townships and villages, and the scope and standards of enjoyment are uniformly formulated by the township-level government. For example, in 1985, 13% of the rural cooperative medical services in suburban counties of Shanghai fell into this model.

4. Township-run and township-governed type. Under this model, the township-level government is responsible for the preparation and establishment of cooperative medical stations (sites), and cooperative medical funds are raised by the township, village, and individuals, and are managed and accounted for by the township. The scope and standards of enjoyment are formulated by the township.

5. Multi-party participation type. Under this model, in addition to rural grassroots governments at the township and village levels, other places participate in the preparation of rural cooperative medical stations (sites). For example, Jinshan County in Shanghai and Jianli County in Hubei have initially established cooperative medical health insurance systems with the support of local governments and the masses. Taking Tingxin Township, a pilot township in Jinshan County, as an example, the township has established a "Cooperative Medical Health Insurance Management Committee", which is managed and coordinated by the county health bureau, county people's insurance branch company and township government. Rural residents are based on household units, townships (including Village) enterprises voluntarily participate as an enterprise, pay a fee to register, and the township "health management committee" will issue a medical care card. With the card, you can see a doctor or be referred step by step, and the medical expenses will be compensated according to a certain proportion. According to statistics, from 1987 to 1989, the township government raised 1.075 million yuan in medical health insurance funds. During the same period, the township paid 1.435 million yuan in medical expenses, of which 413,000 yuan was paid by the patients themselves, and 413,000 yuan was paid by the health care insurance fund. The fund paid 1.022 million yuan and paid an additional 45,000 yuan in management fees. The revenue and expenditure were basically balanced.

6. Serious disease overall planning type.

Under this model, cooperative medical care is only responsible for medical problems in rural society that meet the standards of "serious diseases", and general diseases are not included in the scope of cooperative medical care. For example, Gaoyou City in Jiangsu Province has implemented a cooperative medical system for serious illnesses. Its basic content is: each person pays a pooling fund of about 1.5 yuan per year, which is stored in a special account in the township. Every rural member of society who spends 50 to 100 yuan on medical expenses at one time will be reimbursed 20 yuan. %, 30-40% of a one-time expenditure of 100-500 yuan will be reimbursed, and so on, up to about 70%. More than 700,000 farmers in 32 rural towns in the city have voluntarily participated in this cooperative medical care for serious diseases.

7. Hybrid protection type. Some places have established comprehensive rural grassroots social security systems, including cooperative medical care. For example, Shiku Township, Lucheng County, Shanxi Province, Changyuan Village, Yuantan Town, Linxiang County, Hunan Province, etc., have established township and village grassroots social security systems. System, cooperative medical security and pension security are all its basic contents, so it is networked and comprehensive.

The above-mentioned different models of rural cooperative medical systems are all being explored and developed. There is still debate on whether it is better to run it at the village level or at the township level, and whether it is better to run it individually or comprehensively. Some places call it medical social insurance or medical insurance, which is not true. Therefore, they all belong to rural cooperative medical security, which are consistent in terms of multi-party fundraising, living within one's means, comprehensive services, and protecting residents' health. According to a 1988 sample survey of more than 60,000 rural residents in 20 counties in 16 provinces by the China Rural Healthcare System Research Group, 30% participated in various cooperative medical services; and according to the 1993 "China Tertiary Industry Yearbook" According to the data, by the end of 1992, 294,417 of the 651,031 village-level medical points in rural China were set up by villages or collectives, accounting for 37% (medical points run by individual doctors accounted for 44%, and points set up under rural health centers and other forms (accounting for 19%); a few areas have developed faster. Take Shanghai suburban counties as an example. After the cooperative medical system went through the process of establishment, landslide, and recovery, in 1992, 2875 villages had implemented cooperative medical care, accounting for 96.5% of the rural areas in the suburbs. %. It can be seen that cooperative medical care is moving towards recovery and development in the vast rural areas.